The story of living in spite of melanoma, metastasis, vaccines, anti-PD-1, lung removal, and stereotactic radiation. The story of life with family and friends. {Posts under ~ Sew Chaotically, Travel Chaotically, and Chaotic Cookery also housed within! A girl's gotta have fun!}

About Me

Who am I? That is a question the rest of you could probably answer better than I. I am a wife, mother, daughter, sister, friend, pediatric nurse practitioner, cook, teacher, gardener, lover of words and music, occasional seamstress, and homemaker. I do have a couple of talents of questionable merit: I can create a decent meal in less than 30 minutes. I can feed and/or soothe almost any baby. And I can remember practically any song I've ever heard. For the rest, I'd rather those who know me decide.

Radiological assessment of
response to checkpoint inhibitors remains imperfect. We evaluated individual
lesion and inter-patient response by response evaluation (RECIST) 1.1,
immune-related response criteria (irRC), CHOI and modified CHOI (mCHOI) and
correlated response with overall survival (OS). Thirty-seven patients with
567 measurable lesions treated with pembrolizumab in the Keynote 001 trial were
studied. Association of response with OS was determined. Response varied according to
site; lung lesions had the highest rate of complete response (69 out of 163
(42%) vs other sites 71 out of 404 (18%). Delayed response post
first scan was seen in 2 out of 37 (5%) deemed progressive (PD) by RECIST and 2
out of 14 (14%) deemed PD by irRC. Modified CHOI criteria showed response of
38% (14 out of 37). Change in tumour size and density on first follow-up
assessment was associated with OS with each 1000 mm2 increase in
tumour size from baseline increasing the hazard of dying by 25.9%. Response
defined by any criteria had superior OS. Response by any criterion was prognostic. Novel
patterns of response and changes on treatment in tumour density suggest complex
anti-tumour responses to immunotherapy.

'Pseudoprogression' is often seen in
patients with melanomas who are treated with immune-checkpoint inhibitors such
as nivolumab or ipilimumab. We sometimes evaluate metastatic lesions by imaging
tests such as CT or PET-CT. 'Pseudoprogression'
usually occurs upon the initial administration, which may make it difficult for
the physician to determine the disease condition. In our two cases of metastatic melanoma treated
with nivolumab (anti-PD-1 antibody), we
examined the ultrasonography (US) of target lesions that could be accessed from
the body surface, such as those of the regional lymph node or subcutaneous
metastasis. In both cases, the US
revealed a lesion approximately 10% greater in size after 40-50 days of
nivolumab administration, even though the blood flow inside the tumour was
reduced by about 20% within 50 days. From about 100 days after blood flow
reduction was detected by US, the tumours began to decrease in size. However, contrast CT was unable to detect
the association between tumour size and tumour blood flow. The present cases suggest that US could be
a powerful tool for differentiating between 'pseudoprogression' and real
progressive disease in patients treated with cancer immunotherapies such as
those involving immune-checkpoint inhibitors. The misdiagnosis of progressive
disease can lead to unnecessary alternations in the current treatment.
Therefore, the US findings in our study could be clinically useful and
educational for physicians.

Good data to know when depending on radiology studies as evaluation of status and progression. But wouldn't it be nice to just do a blood draw???? At least some of the time???? - c